L’Hôpital Sainte-Thérèse

Maternity Ward Observations: Midwifery Care in a Haitian Hospital


The sunny, steaming hot morning when I visited L’Hôpital Sainte-Thérèse in Hinche, Haiti, the maternity unit was overflowing with busy midwives checking charts and administering care, nurses-in-training in white and yellow uniforms obtaining requisite clinical hours, as well as a few obstetricians checking on patients. Of course, there were expectant mothers, mothers who had just given birth, and those who were being prepped to deliver their babies. Husbands and other family members milled about slowly, but deliberately, bringing food and water to their loved ones, or just sat on benches and waited.

In each of the maternity units – antenatal, postpartum, and labor and delivery – there was a bed for every woman. No expectant mother laid on the ground waiting for space. In fact, I even saw some empty beds. That is not always the case I was told. Some times of the month are busier than others, but each mother can be accommodated.

Some expectant mothers – many with swollen feet and ankles – walked around slowly outdoors in the sunlight angling for some type of momentary relief from the constant wave of contractions. Others laid in bed with worried eyes anticipating the incumbent pain they faced. When I visited labor and delivery, one mother’s screams were piercing and she wasn’t even pushing yet. Another woman was calm, smiled, and gave me a quick wave as I walked by despite her contractions. Midwives were attending to their care – calmly and respectfully.

The mothers in postpartum care sat with their babies who were asleep and breastfed those who were awake. Husbands, aunts, mothers, or sisters sat at their besides intent to help. Each of the mothers had a look of subtle relief knowing their babies had arrived healthy and alive and they were, too.

Some mothers weren’t as lucky, however. A few Certified Nurse Midwives from Arizona who were volunteering with Midwives for Haiti said two premature babies around twenty weeks didn’t make it in the early morning hours. The mothers rested in postpartum care where three midwives check on women to ensure there is no hemorrhaging or other delivery complications.

Midwives for Haiti has brought a new level of respectful, quality maternal health care to Haiti’s Central Plateau, an area that is quite difficult to reach through the mountains for locals and primarily serves a rural population. Through training and staffing Midwives for Haiti has saved the lives of countless women who choose institutional births at L’Hôpital Sainte-Thérèse. They only lose between one and four mothers per month. Most of the women who do not make it are transferred from outside clinics and are pronounced dead at the hospital. Midwives for Haiti also provides training and clean birth kits to traditional birth attendants who deliver the vast majority of babies across all of Haiti.

In Haiti, 85 percent of women still opt to give birth at home with traditional birth attendants, or matrons as they are called. Most women who decide to give birth at L’Hôpital Sainte-Thérèse come because there are complications with their pregnancies or they live nearby and have easy access to the hospital for delivery with trained midwives. Some women even stay multiple months at the hospital on bedrest.

Compassionate Care

One of the tenets of Midwives for Haiti is training upcoming midwives to practice compassionate care, which is lacking in many low- and middle-income countries. “We’re definitely a balance between what is culturally appropriate and what is being taught in America,” said Emily Davis, Midwives for Haiti Program Coordinator who is based in Hinche. “They are being taught to be kind to women and give women the best possible care.”

I saw that compassionate care when I spent more time in the maternity ward later that day.

A 20-year-old slender, frail woman had come to the hospital at only eight weeks pregnant, but also had what the midwives and nurse volunteers suspected were kidney stones. The woman wailed in pain constantly and flailed around on her bed even though she was hooked to an IV. She nearly ripped it out several times.

The pain was so excruciating that she didn’t cry. I saw no tears. I just heard constant wailing.

“I can’t anymore,” she screamed in Creole repeatedly. “I can’t anymore!” “Oh, my God!”

The midwives and nurse volunteers worked to figure out ways to alleviate her pain. Her husband finally joined her and stood by her bedside. He left to clean her bucket where she constantly vomited during the day. He poured what little water he had left from his water bottle in it.

The woman, still in unbearable pain, hopped out of bed and backed into the wall. She slid down almost to the floor before she fell back into bed again.

The midwife, Miss Val, asked her husband if he could afford to buy pain medications. Equally as young as his wife, he looked bewildered wondering if he had enough money to purchase the medications. It was also getting late in the afternoon and the pharmacy would close soon.

He left and returned sooner than I expected with two doses of tramadol, a pain medication that would be injected every six to eight hours to provide his wife relief. The cost was about $5 US, a fortune for a very poor Haitian.

Miss Val went to the supply closet and prepped a syringe. She walked over to the woman and calmly told her that she needed to turn on her side and that she was going to pull down her skirt to give her the shot of medication.

After nearly fifteen minutes the woman’s wails minimized substantially. The throngs of pain subsided. Her flailing stopped. I could tell she could finally feel the slight breeze from the four fans on the walls that she couldn’t appreciate when she was experiencing excruciating pain.

When I left L’Hôpital Sainte-Thérèse I hoped her husband could afford more medication. Realistically I knew he probably couldn’t. Walking away I couldn’t get the woman out of my mind, but I was relieved to see that she as well as all of the other women I met were afforded quality, compassionate maternal health care by Midwives for Haiti.

Update 5/5/2015: One of the great things about meeting stellar health workers and living with them for just a few days you make bonds you’d never think you’d make.

I left Haiti on a Thursday morning and the aforementioned Certified Nurse Midwives from Arizona who volunteered with Midwives for Haiti stayed until Saturday. They just let me know that the woman who was in such great pain was “induced on Friday night and passed her baby easily. She was suffering from a pregnancy complication of the liver.”

When the CNMs left Hinche for Port-au-Prince on Saturday they stopped to check on her on their way to the airport. They said, “she was out of pain, and was resting and recovering. As soon as she further recovers she will be referred to another hospital for treatment of her kidney stones. She will survive, get treatment and hopefully not have this complication in future pregnancies.”

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